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Public Health Informatics Profile Toolkit
Developing a Public Health Informatics Profile: A Toolkit for State and Local Health Departments to Assess their Informatics Capacity
Developed By: The Minnesota Department of Health
Supported by: The Public Health Informatics Institute & The Robert Wood Johnson Foundation
Public Health Informatics Profile Toolkit Section I: Getting Started | Page 1
Section I:
Getting Started
Public Health Informatics Profile Toolkit
Information systems are vital to public health work: they help practitioners collect, store and use
important data that help drive public health outcomes. However, for years, public health agencies
have faced challenges managing information flow in the digital era. The growing demand for
enhanced electronic exchange with data and clinical partners creates a compelling business need
for agencies to conduct a current state assessment of key information system capabilities to
identify areas for improvement.
The Public Health Informatics Profile Toolkit provides tips, recommendations and resources to
guide public health agencies in implementing a robust informatics department. It is intended to
help uncover the requirements needed for current information systems to better support public
health functions, to facilitate electronic exchange of information and to assist in planning efforts
to modernize information systems to become more standards-based and interoperable.
There are many things to consider before starting an initiative like this, such as developing
a project management plan, developing a business case to garner support for the project,
identifying project stakeholders, and identifying the scope of the project. This section describes
how to develop a broad conceptual overview of the project, and how to define the project scope
and goals.
Defining a conceptual view and project scopeDeveloping a conceptual view of the project in the
form of a diagram or other graphic element can
help clarify your agency’s goals and project scope,
and it can provide a visual tool for communicating
those points to a broad audience. A framework
assists the project by getting everyone on the
same page about what the project entails or
excludes. This view is often conveyed using a
picture or figure. Developing a framework can
be an iterative process and may take multiple
versions before getting it right.
Defining the project scope upfront is also
critical for developing a plan that is realistic and
attainable, and defining the scope early assists
when “scope creep” attempts to broaden the
project beyond the original objectives. There are
many stakeholders to consider, so making the
scope manageable can be challenging. The key is
to keep project parameters narrow.
1. Communicate visually.
Use pictures whenever possible to provide a
visual interpretation for the project.
2. Show how parts connect.
Show how various components/elements are
related to one another to ensure a common
understanding among the project team and
project stakeholders.
3. Be clear.
Keep it simple and include the key elements
that should be conveyed.
4. Explore your options.
Will your assessment be conducted agency-
wide? Will it be limited to systems that have
electronic applications? Do the systems
need to have a certain size or functionality?
Consider the answers to questions like these
first (see Section II).
Public Health Informatics Profile Toolkit Section I: Getting Started | Page 2
5. Include stakeholders.
Identify and engage key stakeholders —
including sponsors and the project team — in
defining your project scope. Brainstorming
sessions can be useful for gathering input.
6. Maximize available resources.
If resources are a constraint, consider what
resources are available before broadening the
project scope.
7. Start with priorities.
Consider relevant factors such as agency
priorities or relevant policy directions as a
place to prioritize.
8. Take into account more than one stage.
Consider multiple phases to your approach.
For example, phase one may be to collect the
most critical information, and phase two may
be to collect information that is less urgent.
Identifying key stakeholdersAs with any project, it is important to identify
key stakeholders and consider their desires and
needs for the project. They can serve as important
champions for the project if they are engaged
early on, particularly if they are able to shape the
project in the definition phase.
1. Remember your project scope.
Consider the planned scope of the project and
identify individuals across the organization
that may have an interest in the project.
2. Communicate properly.
Using the appropriate communication
techniques is important throughout the
entire project.
3. Customize messaging.
Tailor messages to individuals if needed (see
Section III).
4. Seek counsel.
Ask for their help or support of the project.
A
AData Partners (Data Collection by Health Department)
ApplicationsData Sets
Data Partners (Data Recipients from Health Departments)[Individual Level Data • Summary Data • Reports • Publications]
Collecting Data
• Who do we collect data from?
• What data do we collect?
• How do we collect the data?
• What data is exchanged electronically now?
• Readiness/opportunities for electronic exchange
• What data gets stored, analyzed, utilized and managed?
• How is that data represented? Are national standards used?
• What are the future needs related to standards and electronic exchange capacities?
Health Department Informatics Profile Conceptual Model (includes Infrastructure, Data Sets and Applications): For purposes of this survey, the questionnaire will focus on applications, data input, data
output and exchange capabilities of an information system.
• Who do we send data to?
• What data do we send?
• How do we send the data?
• What data is exchanged now?
• Readiness/opportunities for electronic exchange
Sending Data
Public Health Informatics Profile Toolkit Section I: Getting Started | Page 3
Defining goals for and managing a public health informatics profile assessment Because there will be different levels of
understanding among your various stakeholders
about the need for a project like this, it is
important to consider the following:
• Define parameters of project management;
• Describe the context and key drivers;
• Adequately and concretely describe the
business case to justify the project (i.e., what
problems will the profile help solve?);
• Develop a project charter; and
• Secure executive leadership sponsorship for
the project.
Because a project like this may have significant
scope and implications agency wide, it is critical
to create a solid project charter that outlines
important project management principles.
Developing a project charter
The project charter is a vital tool that uses clear
and concise language to describe the goals and
initial project management plan to garner support
for the project. It does not have to be long — many
are just a few pages in length. However, they need
to be detailed yet succinct.
Developing a charter includes building an effective
project team, managing potential project risks,
involving stakeholders and ensuring quality
deliverables. Below are helpful tips for developing
a project charter. For a sample, view our
resources section.
1. Assign a leader.
Designate a lead project manager to oversee
the project schedule, manage scope changes,
identify and resolve issues and be a central
point of contact for the project.
2. Ensure your scope is well-defined.
Clarify the scope of the project early on by
considering the needs of the project sponsor
as well as key stakeholders. The scope should
be clear about what the project will or will
not accomplish.
3. Plan out your project.
Develop a project management plan to use for
overseeing the project once it is initiated.
4. Develop and implement a
communications strategy.
Develop a communications plan to ensure all
stakeholders are kept informed and engaged.
For large projects, conduct a stakeholder
analysis to identify your communications
strategies for different groups based on their
level of interest and their level of influence.
5. Take resources into account.
Be realistic about all the resources you will
need, especially staff and time.
There are other common elements that should
also be included in your charter:
• A solid business case, context, and drivers for
the project (see below)
• Project constraints and assumptions:
assumptions are project factors you assume
to be real, and constraints are existing,
immovable limitations on the project
• Cost and schedule estimates to as much
reasonable detail as possible
• Project sponsor sign-off
Public Health Informatics Profile Toolkit Section I: Getting Started | Page 4
Exploring context drivers for interoperability and modernization of public health information systemsIt is important to be able to articulate the context
and drivers for the public health informatics
profile assessment to various stakeholders with
different perspectives. Some stakeholders will
understand the need for the project early on,
while others will need a little more convincing.
For example, the context or rationale for planning
and conducting your assessment may be the
availability of new funds, to launch a new project,
to respond to external pressures from data
exchange partners, or to respond to new policies
or regulations.
Example drivers on a state and local level
• The desire and need for integrated and
interoperable information at the state or local
health department level to provide higher
quality services and more timely information.
• The need for better electronic exchange
with data partners and expectations of bi-
directional exchanges with the clinical sector,
allowing for improvements in overall clinical
services to patients and population health.
• Organizational needs around project portfolio
management and identifying agency
priorities based on needs and prioritization
of resources.
Example drivers on a national level
Public health agencies are a critical partner in
improving health outcomes. There is a demand for
them to be able to exchange health information
with the private sector when needed with
stakeholders in the health, education and human
services domains. Agencies should therefore be
prepared to assess their information systems
(particularly disease registries and immunizations
registries) to be able to exchange health
information with the private sector when needed.
• Achieving the vision of improvements in
the quality, safety, and efficiency of health
and health care through information and
information technology, including a focus
on population health with the desire that
consumers, health care providers, and those
responsible for population health will have
ready access to timely, relevant, reliable and
secure information.
• The expectation and use of exchange
information electronically by promoting the
use of standards.
• Consumers’ increasing expectations for
electronic government and thus driving
public information system modernization.
• Consumers’ desire to access their information.
• Decreasing levels of resources and the need
for improving workflows in the public sector.
• Changing of the workforce and generational
expectations for electronic information.
• Expectations for rapid, coordinated
responses for natural and human created
disasters and outbreaks.
Public Health Informatics Profile Toolkit Section I: Getting Started | Page 5
Logic model for the nine-dimension evaluation framework to assess public health information systems.
Making the business caseOnce the context and drivers have been
articulated and the key stakeholders have been
identified, a business case can be made to justify
why the project is an important part of a solution
to the context, issues, and challenges you’ve
just described.
1. Tie together the project’s context
and drivers.
Link the project to the context and drivers for
the project; show how it will help solve problems.
2. Coordinate the goals of the project and
your organization.
Ensure alignment of the project to the
strategic direction of the organization by
answering the question, “How will the project
help achieve our strategic goals?”
3. Outline advantages for stakeholders.
Explain how the project will benefit key
stakeholders.
Technical Inputs
Economic Impact• Cost and benefits
quantified, where possible
• Efficiency measures
Individual Impact• Job performance
• Decision-making performance
• Quality of work environment
• Task productivity
• Task innovation
• Customer satisfaction
• Management control
• Training and education
Use• Individual Use: frequency of use, time of use, number of accesses, usage pattern,
dependency, maintaining confidentiality, tracking patients
• Epidemiologic Use: detection and monitoring to support disease and health threat surveillance, analysis of real-time data capture and translation into usable information for people throughout the public health enterprise, tracking population indicators
• Communication and Reporting Use: connections with internal and external partners, timeliness of reporting the screening information to pediatricians, feedback mechanisms to hospitals, implementation of electronic communication standards, transmission of emergency alerts, referrals to health care delivery sector or other providers from public health agency
User Satisfaction• Satisfaction with
information retrieval (related to use dimension)
Program Inputs
Organizational Impact• Organizational
performance
• Managerial value
• Changes to organizational processes
• Redeployment of resources
• Function change
• Cross-program support
• Strategic match with national and state efforts and goals of public health, including compliance enhancements
• Documentation of integration effort
• Policies and Procedures: changes to policies and procedures related to the use of, access to, and facilitation of the integration of information systems
System Quality• Usability (accessibility)
• Availability
• Reliability
• Response time
• Functionality
• Data quality
• Portability
• Improved data capture
• Error reduction
• Use of standards
• Security
Service QualityProviding support for end users, including
• Reliability
• Responsiveness
• Assurance
• Empathy
Information Quality• Accuracy
• Timeliness
• Completeness
• Relevance
• Consistency
Public Health Informatics Profile Toolkit Section II: Assessment Methods | Page 1
Section II:
Assessment Methods
Public Health Informatics Profile Toolkit
It is important to be clear about what datasets or information systems will be included in your
public health informatics profile assessment as there will possibly be items that fall into a gray
area. Being clear about your inclusion and exclusion criteria will allow you to manage the scope of
the project and to succinctly develop the methods (based on your needs) that you use to collect
the assessment data.
Assessment questionsThere are many factors to consider in determining
what questions to ask in the public health
informatics profile assessment. The most
important of which are the purpose and scope
of the assessment: in other words, what system
capacities are you assessing and for what
purpose? Here are some additional tips for
developing questions.
1. Remember stakeholders’ needs.
Consider stakeholders’ needs for information,
and develop questions that meet their needs
(see Section I).
2. Study your information needs.
Consider your data analysis plan to be sure
that you will be collecting the data you need.
3. Define how your data will be used.
Be very clear and concrete about how you will
actually use every bit of information collected.
If you don’t have a clear purpose for a piece of
information, don’t collect it.
4. Evaluate before you implement.
Try to test questions and/or get feedback
on questions as much as possible before
implementing the assessment, since public
health informatics questions may be
complicated and require additional refinement
before implementing.
5. Explain unfamiliar terms.
Provide definitions and agency examples of
terms not commonly understood or terms that
may mean different things to different people.
6. Diversify your questions.
Use a mixture of questions — those that solicit
discreet answers and those that require
descriptive answers.
Collecting the informationThere are several ways that information can be
collected, including surveys, focus groups, and
key informant interviews. Here are some tips for
determining how to collect the information.
1. Keep the details in mind.
Consider your audience, their knowledge level
of the questions, the level of resources you
have, and the timeframe in which you have to
collect the information.
2. Recycle available information.
Use exiting data/information when it exists.
You may be able to save time by validating the
existing information with your responders.
Public Health Informatics Profile Toolkit Section II: Assessment Methods | Page 2
3. Weigh your options for collecting
the information.
In-person interviews work well when questions
are complicated or when a dialogue is desired.
Conversations are important to assure
the responder understands your question
completely. They are also important for
clarifying questions as needed for future
interviews. The risk is that the interviewer can
unintentionally lead the responder to certain
responses. In-person interviews can assist by
increasing the overall response rate.
More traditional surveys can be useful for
simple and straightforward questions that will
be commonly understood among your audience.
Focus groups or group discussions can also be
beneficial when you are interested in more of a
group consensus on a topic.
Conducting the assessmentBecause your survey or focus group respondents
may not have a lot of experience with the type
of questions you are about to ask, it is important
to be effective in your communications about
the project, including why you are collecting the
information and what you will be doing with the
information once it is collected.
1. Start with transparency.
Communicate the purpose of your assessment
upfront and what you’re going to do with
the information.
2. Establish every one’s role.
Explain your role and that of your respondents
in collecting the information.
3. Share your questions prior to conducting
in-person interviews.
Consider providing a copy of the questions
before meeting with people if you have
decided to do in-person interviews. Allow
responders to change their responses if
needed (i.e., after they see a draft report) in
case there was a misunderstanding.
4. Assign a note taker.
If you’re conducting an in-person interview,
have a person taking notes and capturing
responses, and have another person
asking questions.
5. Allot enough time.
Be clear on the amount of time needed and
that some follow-up may be needed.
6. Collect background materials.
Let the program staff know that you may want
to collect copies of existing forms or other
program materials that help describe the
activity and information being used.
Public Health Informatics Profile Toolkit Section III: Creating Your Public Health Informatics Profile | Page 1
Section III:
Creating Your Public Health Informatics Profile
Public Health Informatics Profile Toolkit
After you have developed your questions, gathered your data and conducted your assessment, the next important step is to begin creating your public health informatics profile. Key components in this step include analyzing your data and interpreting and communicating your results. There are important details to remember in each of those phases.
Analyzing the dataAnalyzing the information you’ve collected can be an overwhelming task considering the wide array of information you may have. It is helpful to keep a few important things in mind before beginning to analyze the information you’ve collected.
1. Keep up with your data.Consider creating a spreadsheet or some other database for tracking all of the various responses to questions, both for analysis as well as for future reference.
2. Create an analysis plan.Consider, up front, what information will want to analyze and develop an analysis plan that is in accordance with your original goals/objectives for the project (see Section II).
3. Don’t forget your message.Consider what message you are trying to convey; data can convey different messages depending on how it is represented or displayed.
4. Consider using qualitative data.Qualitative responses can be as, if not more, valuable than quantitative data. Depending on how you collect the information, you may collect a wide range of rich responses. Qualitative analysis, such as identifying themes, can be very effective at communicating a message.
5. Display your results visually.You may want to start by tabulating responses to each question and displaying them in a table. Whenever possible, you may also want to graph your findings (see Section I).
6. Look twice.Consider taking a second look at the data once it is all reviewed to identify possible associations.
Public Health Informatics Profile Toolkit Section III: Creating Your Public Health Informatics Profile | Page 2
Interpreting and communicating the resultsFor your assessment project to have an impact, you must undertake the next two steps. They are all too often not sufficiently emphasized or resourced: (1) knowledgeably interpreting the findings based on your environment and (2) effectively communicating the findings in ways that engage those who can effect change. Here are some tips for interpreting and communicating the results.
1. Confirm your results are justified.Make sure your tables, graphs and figures show the facts. It may be helpful to validate results with interviewees and other key groups to ensure that the information was understood and is consistent with what they were communicating to you.
2. Add your interpretation.If you conducted interviews, use your understanding acquired to provide additional meaning and interpretation of the findings (see Section IV).
3. Encourage respondents to draw their own conclusions.Consider engaging interviewees in drawing conclusions in which they hold a stake. Not only will you draw a better conclusion, and perhaps surface blind spots in your perspectives and conclusions, you will get their support for recommendations emerging from the findings. The results may provide insight into opportunities for different groups to work together to solve a common problem, or they may provide a view of the various systems and needs across an agency, leading to coordinated overall planning efforts for more consistent information exchange, integration, and/or interoperability. They may also reveal challenges that are best addressed collectively.
4. Document and communicate with both immediate and future needs in mind.Display results in a way that even an uninitiated viewer can interpret and understand, and annotate graphs with narrative notes that provide sufficient context for the viewer. While graphs and PowerPoint presentations will likely serve your immediate communication needs—whether for senior leadership, central IT or those who contributed to the data—also consider a full written report for archival purposes. You may want to include key pieces of contextual information about current agency priorities: for example, needing to develop a more coordinated, consistent agency-wide response to Meaningful Use or to receive surveillance data across many programs. Keep in mind that even in two years from now, when you or someone else may want to repeat this assessment, many of the process details and contextual environmental information will have been forgotten. Also include any lessons learned about your data collection instrument and process as an aid to whichever future team repeats the assessment process.
Public Health Informatics Profile Toolkit Section IV: Acting on the Results | Page 1
Section IV:
Acting on the Results
Public Health Informatics Profile Toolkit
Once you have completed your assessment and created a report that provides a comprehensive,
consolidated view of the various information systems, informatics needs, and opportunities within
your defined project scope, you can use the report to inform your planning for next steps.
Using the results to support planningBegin by going back to your original purposes
for conducting the assessment. What were you
seeking to learn? Did you get the information
you needed to answer those questions? Did you
learn things beyond that? What new questions
arose? What themes, common issues and ideas for
improvement emerged from your interviews and
data collection? Do natural collaborations among
programs suggest themselves based on shared
goals or challenges?
1. Collaborate within your agency.
Identify natural partners and collaborators
within your agency based on common ideas or
ideas for improving processes.
2. Take small steps first.
Identify small steps that can be accomplished
incrementally, even if the overall goal seems
daunting.
3. Tackle challenges together.
Identify a suitable model for making decisions
jointly and sharing responsibility. Consider
whether a formal or informal governance model
would work best for you, at least initially.
4. Involve your IT department.
If your jurisdiction has a centralized IT
department, identify how it could support
your efforts. They may also have requirements
which you would need to adhere to in
implementing your plan. You may need to
emphasize that informatics generally, and this
informatics profile in particular, is more about
program information needs and priorities than
about information technology per se.
5. Translate results into goals and plans.
The results will need to be translated into
priorities, goals and activities that can be
incorporated into plans and perhaps budgets
across the agency. Otherwise, its impact will
be minimal.
Acting on the assessment informationThe whole purpose of collecting all the
information you’ve gathered is to support
informed decision making and action. Here,
too, barriers, including project fatigue and new
priorities, can interfere with this critical step.
Other barriers you may need to address can
include a lack of interest or perceived influence
of key decision-makers, competing priorities for
projects and resources, turf issues, and lack of
buy-in or support for the recommendations in
the report.
Public Health Informatics Profile Toolkit Section IV: Acting on the Results | Page 2
When an assessment is conducted agency-wide, it
can be especially challenging to think of where to
start with the recommendations. Sometimes it will
even require a change in the environment before
the findings in your report will take notice.
1. Use compelling recommendations.
Whenever possible, keep recommendations
clear and concrete. If necessary, prioritize
them in order of most importance.
2. Articulate how the results will be turned
into action.
Identify how the results can be translated into
recommendations and priorities that can be
incorporated into agency or program plans
and budgets in a coordinated way.
3. Test out various communication options.
Explore a wide array of approaches in
communicating your message and keeping
people engaged (see Section I).
4. Repeat your message, but change
your delivery.
Repetition is important. Sometimes it takes
people hearing a message multiple times
and in different ways before the message will
begin to sink in. As a result, seek additional
ways to deliver your message, whether it be
through formal communications (e.g., reports,
memos or presentations) or information
communications (e.g., conversations).